Provider Demographics
NPI:1518071703
Name:RIDGEWOOD PEDIATRICS, LLC
Entity Type:Organization
Organization Name:RIDGEWOOD PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EWA
Authorized Official - Middle Name:
Authorized Official - Last Name:DZIARMAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-444-3309
Mailing Address - Street 1:265 ACKERMAN AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4203
Mailing Address - Country:US
Mailing Address - Phone:201-444-3309
Mailing Address - Fax:201-444-3349
Practice Address - Street 1:265 ACKERMAN AVE STE 204
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4203
Practice Address - Country:US
Practice Address - Phone:201-444-3309
Practice Address - Fax:201-444-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06705000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0918458Medicaid